Some urologists call erectile dysfunction (ED) the "canary in a coal mine" of men's health. ED is often the harbinger of cardiovascular health issues due to diabetes, high blood pressure, and high cholesterol.
Urologist Patrick Bennett, MD discusses the link between sexual health and overall health, including risk factors, important screenings, and prevention. Dr. Bennett explains how, depending on the individual patient, treating ED may require collaboration between an urologist and specialists in cardiology or endocrinology.
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Erectile Dysfunction: A Warning Sign for Men
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Learn more about Dr. Bennett
Patrick Bennett, MD
Dr. Bennett joined Marin Specialty Care in 1996. He and his partners value collaboration and a team approach to offer patients the most appropriate, advanced care available, and strive to provide expertise in Marin that is normally associated with academic centers. Dr. Bennett has interest in minimally-invasive procedures, including use of the DaVinci robotic system but also with a broad range of endoscopic and key-hole procedures for urologic cancer, female pelvic prolapse and incontinence, kidney stones and pediatric urology. Dr. Bennett and his wife are both Marin natives and are raising three children here.Learn more about Dr. Bennett
Transcription:
Erectile Dysfunction: A Warning Sign for Men
Bill Klaproth (Host): As men age, sexual health problems become more common. And here to talk with us about sexual health in men, is Dr. Patrick Bennett, chair of the Urology Division at Marin General Hospital and Chief Physician Executive for Marin Healthcare District. Dr. Bennett, thank you so much for your time today. so, let’s start here. What do men need to do in order to manage their sexual health?
Dr. Patrick Bennett, MD (Guest): Well Bill, I think there are – first of all, thanks for inviting me to speak to you today. But I think there are two sides to this. One is general health and the other is relationships and in our community, we have decided to focus on men’s sexual health as sort of a canary in the coal mine that will help us know about someone’s general health overall; particularly cardiovascular health. So, we focus a lot on that. Then in our practice, we also try to get information and come up with ways to strategize improving relationships because that is a big part of the – that’s the tennis partner you are playing with. So, anyway, we – those are the two main ways we approach it.
Bill: So, how do these health management needs, or recommendations change as men age?
Dr. Bennett: As we get older, there is increasing cardiovascular risks, hypertension becomes more common, hyperlipidemia or high cholesterol, diabetes; those are all coming into play. As patients get older, they typically are on more medications and there tends for many men to become more sedentary as they get older. So, over time, these things all creep in and often they change so slowly that folks don’t really realize what’s going on. It is interesting though that it’s been shown in a number of studies that men will often go to the physician to have their erectile function addressed rather than go in to have their blood sugar or their hypertension addressed. So, it’s sort of considered a gateway for many men to get into the system.
Bill: So, you said over time, these health issues just kind of creep in. Are there warning signs that could signal a problem?
Dr. Bennett: Fellows will say that gosh, for the first-time last week or over the last few months or something like that that they have been having difficulty maintaining an erection long enough to satisfy themselves and their partner. So, the warning sign is sort of the, is the erectile dysfunction itself. It’s not something that oh if it’s talking about a knee injury you might say gosh it started to click or hurt when I was running. Usually guys will come in with their principle complaint being heh, my erections used to be great. They are not so great anymore. What’s going on with that?
Bill: So, you said many men come in for ED and that’s kind of like the gateway for men to come in and see the doctor. So, for men to be proactive, what screenings do you recommend for men, again to be proactive with their sexual health management?
Dr. Bennett: I think that men should be screened for hyperlipidemia, and for hypertension. Other risk factors, the blood sugar of course, risk factors for cardiovascular disease and the recommendations I think vary as to what age that should be going on. But, I presume that everyone who is 50 will have had some of that screening done, certainly earlier if they have a strong family history and we all know there is an epidemic of obesity in the country and that’s largely due to our lifestyle which doesn’t involve as much activity as we might pursue and often diets that are not ideal. So, I think those are the sorts of things that certainly by the time a guy is 50 years old, it’s worthwhile monitoring and keeping track of those factors.
Bill: Alright Dr. Bennett, you mentioned hyperlipidemia. Is that a normal part of a routine blood test?
Dr. Bennett: That’s something that can be on most routine screening exams often called a lipid panel and the lipid panel looks at cholesterol and triglycerides and high-density cholesterol, low density, so it’s looking at the classic elements of cholesterol metabolism and again, it’s a pretty routine study. The cardiologists these days will also do a number of other tests looking for risk factors for heart disease. The field changes too quickly for me to be an expert in it, but there are other things that they are looking at as well. In our program, we are coordinated between urologists and endocrinologists who look at hormonal levels and change in testosterone over time as well as a cardiologist and those are all parts of the erectile function and so on. One of the things that we are also looking at right now is how those factors, cardiovascular health for example, is related to prostate cancers. So, it turns out that for men getting older, risk of prostate cancer, risk of erectile dysfunction they sort of have a nexus around cardiovascular risks. So, there is a – we have a sort of broad approach to men with these symptoms again, looking at some sort of cancer risk factors at the same time.
Bill: So, speaking of prostate and potential other specialists, when – and you mentioned before, around 50 years of age, when should a man get a primary care physician or potentially a urologist?
Dr. Bennett: Well, boy that’s a tough question and I don’t feel that I am an expert to determine when one should have their first comprehensive examination, whether it’s with a physician or a nurse practitioner, a physician assistant. That’s a tough one. So, I’d like to defer that to the primary care community who do have guidelines, perhaps based on self-identified risk factors. Urologists really can come in as sort of special teams in this. A lot of this care can be provided by the primary care team. Certainly, those risk factors we discussed and certainly the use of oral medications, the Viagra, Cialis, Levitra, Stendra group. Those are all well within the purview of a current primary care provider physician, physician’s assistant, nurse practitioner, that sort of thing. So, as urologists, we like to get involved – often we are getting involved as the first person to care for the patient, but we are also very happy to collaborate with the primary care community and get involved when patients haven’t had the kind of response to medications that they were hoping for.
Bill: Dr. Bennett, is a urologist a good specialist for a man to manage his health, much like an OB-GYN is for women?
Dr. Bennett: You know, I think that there are some urologists who might feel comfortable with that. I don’t think that that’s ideal in our community. We have a very strong urology program here, but we also know the limits of our expertise and I would hate to overlook some novel treatment or evaluation for a patient coming to me if I were presuming to be the sort of the cardiovascular physician and the manager of other conditions that sort of impinge on their urology health. So, I don’t think that many in our community see their role as the primary care provider, but really more as the specialist to collaborate with the primary care team. Again, you have a more broad view of the patient’s overall health. But again, when patients come to us and they haven’t seen someone else, it is absolutely our responsibility to approach it with a broad perspective and look for other conditions outside of strict urology boundaries and see what the patient needs overall.
Bill: Okay, so that’s really good to know. So, let me ask you this Dr. Bennett. It seems like most common health threats to men are treatable and can be managed with a proactive approach kind of like what we talked about today. So, generally, can you say men just need to go to the doctor on a regular basis? Is that a correct statement?
Dr. Bennett: Yeah, I think that developing a relationship with a provider, a physician or physician extender, absolutely is the first step and I think that working with that physician to develop habits and lifestyles that are conducive to good health overall and good sexual health, that’s critical. I think that going to physicians alone won’t quite do it. But if a patient is willing to initiating in making the kind of changes that will ensure the best health overall, then we have a winning formula.
Bill: That’s excellent. Well, Dr. Bennett, thank you so much for your time today. We appreciate it. For more information you can visit northbayurology.org, that’s norhtbayurology.org. This is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.
Erectile Dysfunction: A Warning Sign for Men
Bill Klaproth (Host): As men age, sexual health problems become more common. And here to talk with us about sexual health in men, is Dr. Patrick Bennett, chair of the Urology Division at Marin General Hospital and Chief Physician Executive for Marin Healthcare District. Dr. Bennett, thank you so much for your time today. so, let’s start here. What do men need to do in order to manage their sexual health?
Dr. Patrick Bennett, MD (Guest): Well Bill, I think there are – first of all, thanks for inviting me to speak to you today. But I think there are two sides to this. One is general health and the other is relationships and in our community, we have decided to focus on men’s sexual health as sort of a canary in the coal mine that will help us know about someone’s general health overall; particularly cardiovascular health. So, we focus a lot on that. Then in our practice, we also try to get information and come up with ways to strategize improving relationships because that is a big part of the – that’s the tennis partner you are playing with. So, anyway, we – those are the two main ways we approach it.
Bill: So, how do these health management needs, or recommendations change as men age?
Dr. Bennett: As we get older, there is increasing cardiovascular risks, hypertension becomes more common, hyperlipidemia or high cholesterol, diabetes; those are all coming into play. As patients get older, they typically are on more medications and there tends for many men to become more sedentary as they get older. So, over time, these things all creep in and often they change so slowly that folks don’t really realize what’s going on. It is interesting though that it’s been shown in a number of studies that men will often go to the physician to have their erectile function addressed rather than go in to have their blood sugar or their hypertension addressed. So, it’s sort of considered a gateway for many men to get into the system.
Bill: So, you said over time, these health issues just kind of creep in. Are there warning signs that could signal a problem?
Dr. Bennett: Fellows will say that gosh, for the first-time last week or over the last few months or something like that that they have been having difficulty maintaining an erection long enough to satisfy themselves and their partner. So, the warning sign is sort of the, is the erectile dysfunction itself. It’s not something that oh if it’s talking about a knee injury you might say gosh it started to click or hurt when I was running. Usually guys will come in with their principle complaint being heh, my erections used to be great. They are not so great anymore. What’s going on with that?
Bill: So, you said many men come in for ED and that’s kind of like the gateway for men to come in and see the doctor. So, for men to be proactive, what screenings do you recommend for men, again to be proactive with their sexual health management?
Dr. Bennett: I think that men should be screened for hyperlipidemia, and for hypertension. Other risk factors, the blood sugar of course, risk factors for cardiovascular disease and the recommendations I think vary as to what age that should be going on. But, I presume that everyone who is 50 will have had some of that screening done, certainly earlier if they have a strong family history and we all know there is an epidemic of obesity in the country and that’s largely due to our lifestyle which doesn’t involve as much activity as we might pursue and often diets that are not ideal. So, I think those are the sorts of things that certainly by the time a guy is 50 years old, it’s worthwhile monitoring and keeping track of those factors.
Bill: Alright Dr. Bennett, you mentioned hyperlipidemia. Is that a normal part of a routine blood test?
Dr. Bennett: That’s something that can be on most routine screening exams often called a lipid panel and the lipid panel looks at cholesterol and triglycerides and high-density cholesterol, low density, so it’s looking at the classic elements of cholesterol metabolism and again, it’s a pretty routine study. The cardiologists these days will also do a number of other tests looking for risk factors for heart disease. The field changes too quickly for me to be an expert in it, but there are other things that they are looking at as well. In our program, we are coordinated between urologists and endocrinologists who look at hormonal levels and change in testosterone over time as well as a cardiologist and those are all parts of the erectile function and so on. One of the things that we are also looking at right now is how those factors, cardiovascular health for example, is related to prostate cancers. So, it turns out that for men getting older, risk of prostate cancer, risk of erectile dysfunction they sort of have a nexus around cardiovascular risks. So, there is a – we have a sort of broad approach to men with these symptoms again, looking at some sort of cancer risk factors at the same time.
Bill: So, speaking of prostate and potential other specialists, when – and you mentioned before, around 50 years of age, when should a man get a primary care physician or potentially a urologist?
Dr. Bennett: Well, boy that’s a tough question and I don’t feel that I am an expert to determine when one should have their first comprehensive examination, whether it’s with a physician or a nurse practitioner, a physician assistant. That’s a tough one. So, I’d like to defer that to the primary care community who do have guidelines, perhaps based on self-identified risk factors. Urologists really can come in as sort of special teams in this. A lot of this care can be provided by the primary care team. Certainly, those risk factors we discussed and certainly the use of oral medications, the Viagra, Cialis, Levitra, Stendra group. Those are all well within the purview of a current primary care provider physician, physician’s assistant, nurse practitioner, that sort of thing. So, as urologists, we like to get involved – often we are getting involved as the first person to care for the patient, but we are also very happy to collaborate with the primary care community and get involved when patients haven’t had the kind of response to medications that they were hoping for.
Bill: Dr. Bennett, is a urologist a good specialist for a man to manage his health, much like an OB-GYN is for women?
Dr. Bennett: You know, I think that there are some urologists who might feel comfortable with that. I don’t think that that’s ideal in our community. We have a very strong urology program here, but we also know the limits of our expertise and I would hate to overlook some novel treatment or evaluation for a patient coming to me if I were presuming to be the sort of the cardiovascular physician and the manager of other conditions that sort of impinge on their urology health. So, I don’t think that many in our community see their role as the primary care provider, but really more as the specialist to collaborate with the primary care team. Again, you have a more broad view of the patient’s overall health. But again, when patients come to us and they haven’t seen someone else, it is absolutely our responsibility to approach it with a broad perspective and look for other conditions outside of strict urology boundaries and see what the patient needs overall.
Bill: Okay, so that’s really good to know. So, let me ask you this Dr. Bennett. It seems like most common health threats to men are treatable and can be managed with a proactive approach kind of like what we talked about today. So, generally, can you say men just need to go to the doctor on a regular basis? Is that a correct statement?
Dr. Bennett: Yeah, I think that developing a relationship with a provider, a physician or physician extender, absolutely is the first step and I think that working with that physician to develop habits and lifestyles that are conducive to good health overall and good sexual health, that’s critical. I think that going to physicians alone won’t quite do it. But if a patient is willing to initiating in making the kind of changes that will ensure the best health overall, then we have a winning formula.
Bill: That’s excellent. Well, Dr. Bennett, thank you so much for your time today. We appreciate it. For more information you can visit northbayurology.org, that’s norhtbayurology.org. This is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.